clopidogrel; if the drug is not activated or activation is decreased,the patient may not receive full protection from myocardialinfarction, thrombotic stroke (caused by clot or blockage in thebrain), and cardiovascular death. Accelerated metabolism of2C19 may result in a patient having problems with spontaneousbleeding episodes and increased risk of hemmoragic stroke(caused by bleeding in the brain). If the prescriber were awarethat a patient’s genetics prevented the drug from attaining adesired response, another medication could be prescribed toavoid complications due to unexpected therapeutic response ofclopidogrel.With approximately 1,900 enzymes being involved in drugmetabolism, these are just two of numerous examples of howgenetic variation of these enzymes can not only lead to suboptimaltreatment, but also serious adverse drug reactions oreven death. Medication-related problems, if thought of as adisease, would be the fifth leading cause of death in the U.S. 4Drug related problems are not only dangerous, but also costly. In one study of UtahMedicaid participants, the average pharmacy cost per month for patients with atleast one drug related problem was $1,081 versus the average pharmacy cost of$91 per month for all other patients receiving at least one prescription. 5 Althoughindividual diversity in drug metabolizing enzymes is not the only cause of adverse drugreactions, utilization of pharmacogenomics and “personalized medicine” can helpdecrease these numbers. According to Dr. Edward Abrahams, executive director of thePersonalized Medicine Coalition, “The point of personalized medicine is to developbetter efficacy, better outcomes, fewer adverse events and lower systemic costs.” Thescience of pharmacogenomics provides the foundation for personalized medicine.Throughout history, medicine and prescribing have evolved with advances in scienceand technology. With the application of personalized prescribing, there can be ashift from “trial and error” prescribing to precision prescribing. When the individualcharacteristics of the patient are considered, adverse medication outcomes can bedecreased and the therapeutic outcomes can be optimized for the patient. A keytool in personalized medicine is the use of pharmacogenetic testing to understandthe extent to which the patient will metabolize, and in turn respond to a medication.Although genetics are not the only cause of drug-related problems, it is one that can bepredicted and avoided with the use of pharmacogenomics. Thus, with a simple test apatient’s medication regimen can be tailored specifically for that patient.Robert L Alesiani, PharmD, GCP, Senior Vice President of Pharmacotherapy andPharmacogenomic Translation, Carekinesis, Inc, Moorestown, NJ 08057Nicole Gogluizza, PharmDc, Doctor of Pharmacy Candidate, Temple University,Philadelphia, PA and Pharmacy Intern, Carekinesis, Inc, Moorestown, NJ 08057References1 Foley K., Quigley D. “Pharmacogenomic potential of psychiatric medications and CYP2D6”.http://www.mlo-online.com/. January 2010; 32-34.2 Ciszkowski C. et al. “Codeine, Ultrarapid-metabolism genotype, and postoperative death”.New England Journal of Medicine 2009; 361;8:827-8.3 Plavix is a registered trademark of Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership4 Lazarou j et al. “Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies”.JAMA 1998; 279:1200-05.5 Lafleur et al. “Prevalence of drug-related problems and cost-savings opportunities in Medicaid high utilizers identified by apharmacist-run drug regimen review center”. JMCP 2006; 12:8: 677-685One new company utilizingpharmacogenomicsis CareKinesis, located inMoorestown, New Jersey.CareKinesis provides personalizedmedication therapy management toindividuals with complex medicationneeds though personalizedmedication management andcustomized medication distributionfor at-risk, elderly populations.CareKinesis partners with healthcareproviders to coordinate routinegenetic testing and translate resultsfor individuals in need. Some of themore common genes probed includeCYP2D6, CYP2C9, CYP2C19,and CYP3A4. Based on the resultsof the genetic tests, CareKinesisPharmDs provide pharmacotherapysuggestions and pharmacogenomicseducation to the prescribers. Thisis all done with the purpose ofmeasurably enhancing the qualityof life of the patient by assuringappropriate medication selection,which leads to improved medicationoutcomes and reduced costs.14LifeSci Trends | www.njtc.org | September 2011
November 17, 2011The Addison Park, Aberdeen, NJCelebrating 15 Years2011 NJTC AWARDS GALA SPONSORSThe Council will recognize andcelebrate New Jersey technologycompanies and their leaders forbusiness accomplishments intechnological innovation. Winnersare posted at www.njtc.orgAs part of the 15th anniversarycelebration, the NJTC will hold itssecond Hall of Fame induction atthe Gala.Contact Meredith Meyer at mmeyer@njtc.org to reserve your space.
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